Background: Increasing numbers of elderly patients are admitted to hospital. Ensuring that they are given appropriate and timely access to the range of hospital and community medical, rehabilitation and social care facilities has become more difficult due to the complexity of management options now available, and limited senior medical staff time.
Methods: We established a scheme in which specialist nurses made first assessments of all inter-departmental referrals to a hospital department of geriatric medicine. We evaluated the scheme prospectively using process and outcome data.
Results: 2825 new patients were seen by two nurses in the first two years, an average of 5.4 per weekday (range 0-17). Mean time from admission to referral was 9 days. Most referrals were seen within 1 day. Mean total length of hospital stay was 43 days (range 1-351). Seven percent died on the referring ward, and 31% were discharged directly from the referring ward. Almost half were accepted for in-patient rehabilitation. Sixty percent of these were discharged home. Thirteen percent were transferred to an acute geriatric medical or stroke ward. One-quarter of these died. Senior medical review was requested in 8% of cases.
Conclusions: Nurses could select patients suitable for rehabilitation, identify those requiring on-going acute in-patient care, and make arrangements for supported direct discharges where appropriate. This model facilitated access to a wide array of discharge and community support schemes, and supported the efficient use of consultant time.